tag:theconversation.com,2011:/ca/topics/illness-24381/articlesIllness – The Conversation2017-09-04T12:16:34Ztag:theconversation.com,2011:article/832492017-09-04T12:16:34Z2017-09-04T12:16:34ZJust like humans, more cats and dogs are living with chronic health conditions<figure><img src="https://images.theconversation.com/files/184366/original/file-20170901-27307-mboa19.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">As sick as a dog.</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>About <a href="https://www.kingsfund.org.uk/projects/time-think-differently/trends-disease-and-disability-long-term-conditions-multi-morbidity">15m people</a> in England have a long-term health condition, such as diabetes, persistent pain or arthritis. </p>
<p>Living with this type of a health problem can have a huge impact on a person’s life. And for a lot of these people, the situation is complicated by the fact their condition is often “<a href="https://butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/">invisible</a>” – so it isn’t initially obvious to others there is anything wrong. A lot of these conditions also don’t have a cure, but are managed with a range of treatments such as drugs or physiotherapy along with psychological interventions. Some people also turn to alternative therapies such as acupuncture.</p>
<p>According to the <a href="https://www.gov.uk/government/publications/long-term-conditions-compendium-of-information-third-edition">Department of Health</a> not only are the numbers of people living with these types of long term health conditions increasing, but there has also been a rise in the number of people living with more than one. </p>
<p>And now it seems the same can be said for our household pets. The UK based <a href="http://www.cats.org.uk/uploads/documents/cat-care-leaflets-2013/EG16_Elderly_cats.pdf">Cats Protection</a> outlines in their leaflet the age associated disorders that your elderly cat may develop and they include arthritis, diabetes, hyperthyroidism or renal impairment. </p>
<h2>Why the increase?</h2>
<p>One of the main reasons for the <a href="http://www.annualreviews.org/doi/pdf/10.1146/annurev-psych-010416-044014">rise of chronic conditions</a> in both humans and domestic animals is that we are all living longer. According to the writer <a href="http://www.sacbee.com/entertainment/living/pets/article49611725.html">Cynthia Hubert</a> our dogs and cats are living longer than ever before – 16-20 years is not uncommon these days. For both humans and pets, this longevity is largely down to increased access to vaccines, healthcare, and good nutrition. </p>
<p>But while life expectancy for humans and domestic pets has increased, it is still of course the case that in the wild, animals that are not in peak condition will die early or be picked off by predators. For most humans though, gone are the days of starving to death because of a broken leg or swollen ankle.</p>
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<span class="caption">It’s a dog’s life.</span>
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<p>The <a href="http://www.who.int/chp/chronic_disease_report/full_report.pdf">most common causes of death</a> these days are conditions that are associated with what’s known as “<a href="https://www.phpc.cam.ac.uk/pcu/wp-content/files/2012/01/Ch-04.pdf">health impairing behaviours</a>”. We drink too much alcohol, we eat too much of the wrong foods, we don’t take enough exercise, we smoke. And all these behaviours can lead to an <a href="http://www.who.int/chp/about/integrated_cd/en/">increased likelihood</a> of developing a chronic condition.</p>
<p>That is not to say that all chronic diseases are avoidable and that anyone with a chronic disease has brought it upon themselves – some chronic illnesses are of course completely unavoidable. But if you think about most people’s typical working day it might look something like this: walk to the car and drive to work. Walk from the car to the desk. Sit. Eat at the desk. Finish work. Walk to the car. Drive home. Walk to the house. Sit. Eat. Go to bed. And start all over again the next day. </p>
<p>It is clear then that few of us are taking the recommended minimum amount of exercise – which is <a href="http://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-adults.aspx">at least 150 minutes of moderate aerobic activity</a> or 75 minutes of vigorous aerobic activity a week. Even just ten minutes brisk walking each day can help to <a href="https://www.gov.uk/government/news/6-million-adults-do-not-do-a-monthly-brisk-10-minute-walk">reduce the risk of developing chronic disease</a>. </p>
<p>So it is not only the fact that we are living longer, but it’s also the way we are living which is making humans more susceptible to chronic disease. The same can be said for our pets. A <a href="http://www.dailymail.co.uk/news/article-1300658/Walkies-Fat-chance-One-dog-owners-lazy-pets-day.html">survey from the Kennel Club</a> has shown that not enough dogs are getting their <a href="http://www.telegraph.co.uk/technology/news/11411467/Is-your-dog-getting-enough-exercise.html">daily exercise</a>, with one in five dog owners too lazy to take their pets out every day.</p>
<p>Recent estimates also show that almost <a href="http://www.telegraph.co.uk/lifestyle/pets/10747181/Nearly-half-of-dogs-are-now-obese-say-vets.html">half of all cats and dogs are now obese</a>. And that these numbers are <a href="https://www.theguardian.com/uk-news/2015/mar/26/pet-obesity-a-growing-problem-in-the-uk">expected to rise</a> in coming years – as more pets (like humans) live sedentary lifestyles and eat too much food. </p>
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<span class="caption">Not enough walkies.</span>
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<p>But if we could change our behaviour (and that of our pets), just a little bit, we could do much to reduce the likelihood that we develop a chronic illness in the first place. </p>
<p>These don’t have to be massive changes either. Small changes to our behaviour and our habits can have a big payoff. These could include making healthy eating choices, moderating drinking, and stopping smoking. You should also try to take more exercise – do it for yourself, do it for the dog, just make sure you do it together.</p><img src="https://counter.theconversation.com/content/83249/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Rodham does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A longer life for humans and pets means more challenges for doctors and vets.Karen Rodham, Professor of Health Psychology, Staffordshire UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/823582017-08-18T12:19:04Z2017-08-18T12:19:04ZHow tranquil spaces can help people feel calm and relaxed in cities<figure><img src="https://images.theconversation.com/files/182225/original/file-20170816-32661-1u6lzxd.jpeg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">A little piece of calm.</span> <span class="attribution"><span class="source">Pexels</span></span></figcaption></figure><p>When you think about somewhere that is tranquil, what do you imagine? Whether it’s a wide open meadow, a deserted beach, or a river as it lazily flows along on a warm summer’s afternoon, <a href="https://http://bradscholars.brad.ac.uk:8080/bitstream/handle/10454/5561/EPB%20138-061_final%20for%20printing_DC2.pdf?sequence=1&amp;isAllowed=y">research shows</a> tranquillity is mainly found in natural outdoor environments. </p>
<p>These tend to be places where man-made noise is at a low level, but where natural sounds – such as bird song – can be relatively high. Such studies have also shown a link between these types of environments and levels of relaxation, stress reduction and even longevity and pain relief.</p>
<p>It’s clear then that tranquil spaces are good for your health – and yet the world’s population is <a href="http://www.un.org/en/development/desa/news/population/world-urbanization-prospects-2014.html">becoming increasingly urban</a>. There are more trucks, cars, and motorcycles on the roads than ever before resulting in higher levels of noise, pollution and litter. If you live in a busy city, finding tranquillity in your daily life can be a challenge.</p>
<h2>Maximum tranquillity</h2>
<p>To find out what actually makes somewhere tranquil, we developed the <a href="https://www.researchgate.net/profile/Rob_Pheasant/publication/281400420_Tranquillity_rating_prediction_tool_TRAPT/links/566e933908ae1a797e4069d9.pdf">Tranquillity Rating Prediction Tool</a>. The tool measures two factors, the level of man-made noise – usually traffic – as well as the percentage of natural and contextual features in view. This includes things like if a place has a water feature, and lots of greenery. or if a place gives you a view of a religious or historic building – all of which our research shows help to boost the tranquillity of a place.</p>
<p>Based on these factors, the tool can predict the tranquillity of a place on a scale of 0-10. This is based on laboratory studies where people were asked to rate video clips of a range of environments for tranquillity levels. These clips included diverse settings, from a busy market place to natural coastal locations far from any development. Using this method we can not only identify existing (and sometimes overlooked) tranquil spaces, but also offer advice on how urban areas can be made more tranquil. </p>
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<span class="caption">The High Line park in Manhattan, New York, is a good example of a tranquil space that is part of a wider urban environment.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/w/index.php?curid=24266371">InSapphoWeTrust</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
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<p>Our research shows that green spaces on side roads, which are often hidden from view, tend to have high levels of tranquillity due to the screening effects of buildings from the noise of busy streets. Pedestrianised squares in towns and cities were also shown to be acceptably tranquil because of the distance from traffic – some of these squares also featured grass and trees.</p>
<p>Similarly, well-maintained side streets – especially with avenues of trees – or heritage buildings can also score highly due to good visual attributes combined with low traffic noise. Close proximity to water was also shown to be good for tranquillity because it is naturally nice to look at and is relaxing to listen to. </p>
<h2>Creating tranquil spaces</h2>
<p>To boost the tranquillity of an area, the first step is to reduce man-made noise. Obviously on a city scale this could be done by things like rerouting traffic, lorry bans and low-noise road surfacing, as well as noise barriers. But in terms of your own surroundings, anything you can do to reduce unnatural noise the better. Higher and longer fences and walls next to the road can help here. As can creating a small quiet area with perhaps a natural-sounding water feature close by.</p>
<p><a href="http://online.liebertpub.com/doi/abs/10.1089/acm.2009.0531">Increasing the percentage of natural features</a> through “greening” can also help to boost the tranquillity of an area. Introducing more trees, shrubs, or trellising to “hide” building facades, makes people feel less stressed and calmer in their surroundings – so go wild with the greenery.</p>
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<span class="caption">Back Bay in Boston, US, is a great example of the benefits of ‘greening’ residential areas.</span>
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<p>Having “natural” sounds can also help to make a place feel more tranquil. This could be done by installing a water feature or pond. This which will not only help in terms of relaxation but it will also encourage water fowl and birds.</p>
<p>What all this shows is that creating a refuge from the din of city life doesn’t have to be a huge task. And it is often neglected green spaces that can be re-imagined as havens of tranquillity. </p>
<p>So next time you’re feeling stressed out, try and find a tranquil space, or even better make one of your own – that way your can get your little bit of calm anytime you want.</p><img src="https://counter.theconversation.com/content/82358/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Greg Watts does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research shows tranquility can help to boost levels of relaxation, reduce stress and even provide pain relief.Greg Watts, Professor of environmental acoustics, University of BradfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/779882017-05-19T11:58:38Z2017-05-19T11:58:38ZWhat it’s really like to live with dementia<figure><img src="https://images.theconversation.com/files/170020/original/file-20170518-12260-l0kohf.jpeg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Pexels</span></span></figcaption></figure><p>More than <a href="https://www.alzheimers.org.uk/info/20027/news_and_media/541/facts_for_the_media">225,000 people develop dementia</a> every year – that’s roughly one person every three minute. At the moment, <a href="https://www.alzheimers.org.uk/info/20027/news_and_media/541/facts_for_the_media">850,000 people in the UK</a> are living with dementia. This figure is set to rise to two million by 2051.</p>
<p>Dementia is a progressive disease of the brain that mainly affects older people – although is not a “normal” part of ageing. Of the 850 000 known cases of dementia in the UK, <a href="https://www.alzheimers.org.uk/info/20027/news_and_media/541/facts_for_the_media">some 40,000 are aged under 65</a>. </p>
<p>It is a collection of brain diseases – with <a href="https://theconversation.com/if-you-develop-alzheimers-will-your-children-get-it-too-62986">Alzheimer’s the most common</a> – and is not just about memory loss. Everyone experiences it differently, from behaviour change, to difficulty processing conversations, to confusion over everyday tasks – such as working out how to make a cup of tea.</p>
<p>As academics researching in this area with other organisations, we work directly alongside people living with dementia, as well as their carers, families and communities. And while we understand a lot about the disease – including how it affects a person’s health and the impact it can have on their personal lives – we do not know what it’s really like to live with dementia, day in, day out. </p>
<h2>Gym and swim</h2>
<p>This is why it’s critical to listen to those who can tell it as it is – which is what a large part of our research is about. Susan Small who was a dementia support worker and a carer says:</p>
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<p>People should not be defined by their dementia, but given opportunities and experiences to enjoy life and relationships – and indeed take a few risks now again. We need to learn to listen more to what the person with dementia is telling us.</p>
<p>It is important for people to get a correct, early diagnosis, as long as it is followed up with timely information and support. Too little information can leave the person with dementia and those close to them, feeling ill prepared – yet too much information can leave people fearful of their future.</p>
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<span class="caption">Being around family and friends is important.</span>
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<p>Barbara Dow who cared for her husband Al and is now a dementia campaigner agrees, stressing that a timely diagnosis enabled them to plan for the future together. This meant they could move house to be nearer to family and facilities where they could both continue much loved hobbies such as dancing. She said:</p>
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<p>Al continued to lead a full life to the best of his abilities. If he could not dance, then he could go to the gym and swim. </p>
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<p>She also speaks of humour lessening frustration and maintaining self-esteem: </p>
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<p>Al might forget who had just spoken on the phone. We used to say it was Mr or Mrs Whatsit, have a bit of a laugh together about it and then I would dial 1471.</p>
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<h2>My life, my terms</h2>
<p>People living with dementia – and their carers – also speak of the need to emphasise what is achieved, rather than what isn’t. </p>
<p>Ken Clasper, a university college engineer, was diagnosed with Lewy Body dementia at the age of 56. This is the same type of dementia that actor <a href="https://theconversation.com/robin-williams-had-dementia-with-lewy-bodies-so-what-is-it-and-why-has-it-been-eclipsed-by-alzheimers-50221">Robin Williams had</a> and can cause depression, paranoia, Parkinson’s disease and confusion.</p>
<p>Clasper told us that although he may need more time to process information, “please don’t answer for me, just give me time”. He suggests that it’s also important for others to know the person with dementia, and for example, their life-long interests and passions. He is a keen nature lover and photographer and bought equipment that helps him to continue to take photographs. </p>
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<span class="caption">Dementia doesn’t have to mean the end of hobbies and interests.</span>
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<p>Other people with dementia have spoken of enjoying being outdoors on their own, and while this may cause some understandable anxiety to friends and family, they stress the importance of being able to “get on with life in their own way” – with family and community support. </p>
<h2>Learning to adapt</h2>
<p>These experiences show that much of living with dementia is about cycles of loss and adjustment, of change and adaptation – and of partial resolution. Partial, because life does not stay the same – we shift and change with circumstance as a progressive disease is experienced and lived through. </p>
<p>As the <a href="http://www.alzheimersresearchuk.org/what-if-santa-forgot/">Alzheimer’s Society’s campaign</a> to unite against dementia succinctly portrays, how this indiscriminate disease can affect anyone.</p>
<p>How a person might live with dementia depends on who they are, their own individual diagnosis as well as their support network and connections. But it is important to remember that people can and do live well with dementia.</p>
<p>Of course, there will be peaks and troughs, good days and bad, but rather than just seeing everyone with dementia as “sufferers”, or as “brave battlers” of a debilitating disease, it is important to remember that dementia can be lived with as well. To do this, we need to listen to and learn from, those who know what it’s really like – those people who have the actual lived experience.</p><img src="https://counter.theconversation.com/content/77988/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Bailey has and is receiving funding from Comic Relief, National Institute of Health Research, NHS Trusts, and other funding bodies as she is an academic doing contract and grant research,
She is a member of the British Social Gerontology Society and the North East Dementia Action Alliance. </span></em></p><p class="fine-print"><em><span>Katie Brittan has recieved funding from NIHR, Wellcome Trust, EPRSC, ESRC and other funding bodies and is currently receiving funding from the NIHR. She is also a trustee of a dementia voluntary organisation, Silverline Memories.</span></em></p><p class="fine-print"><em><span>Sue Tiplady does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>What does dementia feel like?Catherine Bailey, Senior Research Fellow in Public Health and Wellbeing, Northumbria University, NewcastleKatie Brittain, Associate Professor of Ageing & Health, Northumbria University, NewcastleSue Tiplady, Senior Lecturer Adult Nursing, Northumbria University, NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/729702017-03-21T01:41:42Z2017-03-21T01:41:42ZTo be ill is human: why normalising illness would make it easier to cope with<figure><img src="https://images.theconversation.com/files/160281/original/image-20170310-3687-vm027y.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">We often hide behind a mask of wellness when we&#39;re really sick. Maybe it&#39;s time to be more open about our health.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?src=p9qu7dP7M-sqD6MbWJaglg-1-4">from www.shutterstock.com</a></span></figcaption></figure><p>Why are we so shocked when we, or someone we know, becomes ill? Why are many people scared of illness and unable to support their loved ones when illness strikes? And why do so many people still think “it won’t happen to me”?</p>
<p>These questions strike at the heart of our relationship between sickness and health and our reluctance to confront illness as part of our everyday lives.</p>
<p>Many people do not talk openly about illness because they fear it will make them seem weak or <a href="http://onlinelibrary.wiley.com/doi/10.1002/pon.2048/full">self-indulgent</a>.</p>
<p>People also keep illness a secret because they worry they will be <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1467-9566.2010.01322.x/full">blamed</a> or <a href="https://theconversation.com/its-your-fault-you-got-cancer-the-blame-game-that-doesnt-help-anyone-66995">judged for developing it</a>, which is surprisingly common. For example, think about the stigma patients and their families experience if they are affected by <a href="http://www.bmj.com/content/328/7454/1470.long">lung cancer</a>, <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0046924">obesity-related illness</a> or <a href="http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&amp;id=2006-07278-007">mental illness</a>.</p>
<p>This fear of being judged or blamed may also contribute to people hiding their symptoms, even from health professionals, delaying <a href="http://www.nature.com/bjc/journal/v112/n1/abs/bjc2014516a.html">diagnosis</a> and proper <a href="https://academic.oup.com/eurpub/article/24/5/761/474150/Delays-in-diagnosis-and-treatment-of-breast-cancer">management</a>. </p>
<p>Perhaps we don’t talk about illness because of the global <a href="http://www.forbes.com/sites/liyanchen/2015/12/21/the-most-profitable-industries-in-2016/#675590f37a8b">multi-billion dollar health industry</a> reinforcing a message that we must be healthy if we consume the right <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1467-9566.2008.01121.x/abstract">food and drinks</a>. </p>
<p>Or perhaps we don’t talk about our illness because we believe modern medicine will cure us.</p>
<p>All of these factors mean remaining quiet about illness becomes normal, illness is often hidden and many people cope with illness alone. While it may be acceptable to talk about having a common cold, it seems that speaking about more serious illness is not. Sometimes we hide away our health troubles behind a mask of wellness. </p>
<p>About a <a href="http://onlinelibrary.wiley.com/doi/10.1002/pon.3679/abstract">quarter</a> to a <a href="https://www.diabetes.org.uk/About_us/News_Landing_Page/One-million-risk-health-by-keeping-diabetes-secret/">third</a> of people with serious physical illnesses hide their illness from colleagues and even family and friends. The data is even more striking when considering mental health problems, with studies suggesting more than <a href="http://www.rand.org/pubs/research_reports/RR1074.html">two-thirds</a> of people would conceal a mental illness from their co-workers or classmates.</p>
<p>So, it is hardly surprising people are not prepared when they, or a loved one, become ill; they can find it hard to <a href="http://www.jclinepi.com/article/0895-4356(90)90123-7/fulltext">cope</a> psychologically with, and adjust to, their and other people’s illness.</p>
<h2>Serious and chronic disease is common</h2>
<p>Society seems in a state of denial that illness is a fact of life for most families. It is part of the human condition.</p>
<p>Serious and chronic illness is <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/chronic-disease">becoming more common</a>. At any one time, about half of us will be managing a serious health condition and around one in five of us will be experiencing <a href="http://www.aihw.gov.au/media-release-detail/?id=60129552034">two or more serious illnesses</a> at once. </p>
<p>No family is immune: serious illness can affect people of all ages, wealth, professions and education levels. Celebrities also develop serious <a href="http://www.livescience.com/36251-celebrity-health-illness-diseases.html">illnesses</a> (although many likely keep their health problems private).</p>
<p>Look around you. Who in your family is ill? Who is off work because they are sick with something other than a common cold? Who has been diagnosed with a life-threatening condition (cancer, diabetes and heart disease spring to mind) or with a chronic condition such as inflammatory bowel disease, arthritis or depression?</p>
<h2>Living with illness</h2>
<p>We are now coming to understand that many life-threatening diseases are in reality long-term conditions rather than a death sentence. Many people are managing multiple serious illnesses at once, while others are told they are at risk of developing a serious illness in the future. If your family, friendship circle and workplace is anything like ours, then being ill is surprisingly common.</p>
<p>There are a number of different psychological approaches to help us cope with these long-term health problems.</p>
<p>So-called <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008704.pub2/abstract">third wave psychological therapies</a> promote the idea of accepting rather than avoiding illness, and the pain and suffering that often accompanies it. These types of therapies may help us to cope when illness strikes. They can help patients to clarify their values and make choices that align with them.</p>
<p>Other more traditional psychological approaches (such as <a href="https://theconversation.com/explainer-what-is-cognitive-behaviour-therapy-37351">cognitive behaviour therapy</a>) may also help people who are struggling with their health to re-frame their illness as part of the normal experience and identify effective coping strategies. They may also help people to identify their needs and seek help to meet these needs.</p>
<p>For young people who are ill, more modern approaches, using internet-delivered support may meet their needs well, for instance this <a href="https://bmccancer.biomedcentral.com/articles/10.1186/1471-2407-12-339">online intervention</a> for young cancer survivors. </p>
<p>And when an illness becomes terminal, psychological therapies and bereavement counselling can help patients, families and friends to face the end of life. </p>
<p>These forms of support may help people thrive with illness rather than despite their illness. But society also needs a “therapy” to cope with people being ill. </p>
<p>For starters, we need to see people who are not 100% healthy represented in the government, workplace and media, in fact in all areas of social life. This should lead to greater acceptance of illness and position ill health as the new normal.</p>
<hr>
<p><em>If this article has raised issues for you or if you’re concerned about someone you know, call Lifeline on 13 11 44.</em></p><img src="https://counter.theconversation.com/content/72970/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gill Hubbard currently receives research funding from Chief Scientist Office ( Scotland) and the charity, Melanoma Focus</span></em></p><p class="fine-print"><em><span>Claire Wakefield receives funding from the National Health and Medical Research Council Australia. Her research is supported by a Harry McPaul Cancer Council NSW Program Grant (PG16-02), as well as other research grants from Cancer Australia, Children&#39;s Cancer Institute and The Kids Cancer Project. The Behavioural Sciences Unit is supported by the Kids with Cancer Foundation. </span></em></p>Why are we so shocked when we, or someone we know, becomes ill? It's time to reclaim sickness as a normal part of life.Gill Hubbard, Reader in Cancer Care, University of StirlingClaire Wakefield, Associate Professor, UNSWLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/709192017-02-13T09:24:37Z2017-02-13T09:24:37ZBeing lovesick was a real disease in the Middle Ages<figure><img src="https://images.theconversation.com/files/156336/original/image-20170210-23350-m0q7zk.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Cupid shoots an arrow in the &#39;Roman de la Rose&#39;. 14th century, MS NLW 5016 // Wikimedia Commons</span></span></figcaption></figure><p>Love sure does hurt, as the <a href="https://www.youtube.com/watch?v=Db47zLee3vA">Everly Brothers knew</a> very well. And while it is often romanticised or made sentimental, the brutal reality is that many of us experience fairly unpleasant symptoms when in the throes of love. Nausea, desperation, a racing heart, a loss of appetite, an inability to sleep, a maudlin mood – sound familiar?</p>
<p>Today, research into the <a href="http://onlinelibrary.wiley.com/doi/10.1016/j.febslet.2007.03.094/full">science of love</a> recognises the way in which the neurotransmitters dopamine, adrenalin and serotonin in the brain cause the often-unpleasant physical symptoms that people experience when they are in love. A <a href="http://jn.physiology.org/content/94/1/327.full#R48">study in 2005</a> concluded that romantic love was a motivation or goal-orientated state that leads to emotions or sensations like euphoria or anxiety.</p>
<p>But the connection between love and physical affliction was made long ago. In medieval medicine, the body and soul were closely intertwined – the body, it was thought, could reflect the state of the soul.</p>
<h2>Humoral imbalance</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/154447/original/image-20170126-30424-1jp20eq.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img alt="" src="https://images.theconversation.com/files/154447/original/image-20170126-30424-1jp20eq.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=237&amp;fit=clip"></a>
<figcaption>
<span class="caption">Text and tabular of humours and fevers, according to Galen, c.1420. In MS 49 Wellcome Apocalypse, f.43r.</span>
<span class="attribution"><span class="source">Wellcome Library</span></span>
</figcaption>
</figure>
<p>Medical ideas in the Middle Ages were based on the doctrine of the four bodily humours: blood, phlegm, black bile and yellow bile. In a perfectly healthy person, all four were thought to be perfectly balanced, so illness was believed to be caused by disturbances to this balance. </p>
<p>Such ideas were based on the ancient medical texts of physicians like Galen, who developed a system of temperaments which associated a person’s predominant humour with their character traits. The melancholic person, for example, was dominated by the humour of black bile, and considered to have a cold and dry constitution.</p>
<p>And as <a href="https://medievalmetamorphoses.wordpress.com/publications/">my own research</a> has shown, people with a melancholic disposition were thought, in the Middle Ages, to be more likely to suffer from lovesickness.</p>
<p>The 11th-century physician and monk, <a href="https://books.google.co.uk/books?id=doUoAQAAMAAJ&amp;q=viaticum+mary+wack&amp;dq=viaticum+mary+wack&amp;hl=en&amp;sa=X&amp;ved=0ahUKEwiH9If2t-DRAhXKDcAKHXu7CpsQ6AEIGjAA">Constantine the African</a>, translated a treatise on melancholia which was popular in Europe in the Middle Ages. He made clear the connection between an excess of the black bile of melancholy in the body, and lovesickness:</p>
<blockquote>
<p>The love that is also called ‘eros’ is a <em>disease</em> touching the brain … Sometimes the cause of this love is an intense natural need to expel a great excess of humours … this illness causes thoughts and worries as the afflicted person seeks to find and possess what they desire.</p>
</blockquote>
<h2>Curing unrequited love</h2>
<p>Towards the end of the 12th century, the physician <a href="http://faculty.bsc.edu/shagen/STUDENT/Lovesick/Pages/gerard.html">Gerard of Berry</a> wrote a commentary on this text, adding that the lovesick sufferer becomes fixated on an object of beauty and desire because of an imbalanced constitution. This fixation, he wrote, causes further coldness, which perpetuates melancholia.</p>
<p>Whoever is the object of desire – and in the case of medieval religious women, the beloved was often Christ – the unattainability or loss of that object was a trauma which, for the medieval melancholic, was difficult to relieve.</p>
<p>But since the condition of melancholic lovesickness was considered to be so deeply rooted, medical <a href="https://books.google.co.uk/books?id=rcpjAWNNiXYC&amp;printsec=frontcover&amp;dq=noga+arikha+passions+and+tempers&amp;hl=en&amp;sa=X&amp;ved=0ahUKEwj-652Dh-DRAhWoKMAKHUGHAUkQ6AEIKDAA#v=onepage&amp;q=noga%20arikha%20passions%20and%20tempers&amp;f=false">treatments</a> did exist. They included exposure to light, gardens, calm and rest, inhalations, and warm baths with moistening plants such as water lilies and violets. A diet of lamb, lettuce, eggs, fish, and ripe fruit was recommended, and the root of hellebore was employed from the days of Hippocrates as a cure. The excessive black bile of melancholia was treated with purgatives, laxatives and phlebotomy (blood-letting), to rebalance the humours.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/154448/original/image-20170126-30419-tal8x6.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip">
<figcaption>
<span class="caption">Blood-letting in Aldobrandino of Siena’s ‘Régime du Corps’. British Library, MS Sloane 2435, f.11v. France, late 13thC.</span>
<span class="attribution"><span class="source">Wikimedia Commons</span></span>
</figcaption>
</figure>
<h2>Tales of woe</h2>
<p>It is little wonder, then, that the literature of medieval Europe contains frequent medical references in relation to the thorny issue of love and longing. Characters sick with mourning proliferate the poetry of the Middle Ages. </p>
<p>The grieving Black Knight in Chaucer’s <a href="http://www.librarius.com/duchessfs.htm">The Book of the Duchess</a> mourns his lost beloved with infinite pain and no hope of a cure: </p>
<blockquote>
<p>This ys my peyne wythoute red (remedy),<br>
Alway deynge and be not ded. </p>
</blockquote>
<p>In Marie de France’s 12th-century <a href="https://books.google.co.uk/books?id=bXCUKl44F3YC&amp;dq=lais+de+marie+de+france&amp;hl=en&amp;sa=X&amp;ved=0ahUKEwj0tI68xODRAhVHGsAKHWy-DYIQ6AEIKTAB"><em>Les Deus Amanz</em></a>, a young man dies of exhaustion when attempting to win the hand of his beloved, who then dies of grief herself. Even in life, their secret love is described as causing them “suffering”, and that their “love was a great affliction”. And in the anonymous <a href="http://d.lib.rochester.edu/teams/text/stanbury-pearl">Pearl</a> poem, a father, mourning the loss of his daughter, or “perle”, is wounded by the loss: “I dewyne, fordolked of luf-daungere” (I languish, wounded by unrequited love).</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/154450/original/image-20170126-30428-1jgxoaj.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip">
<figcaption>
<span class="caption">The lover and the priest in the ‘Confessio Amantis’, early 15th century. MS Bodl. 294, f.9r.</span>
<span class="attribution"><span class="source">Bodleian Library, Oxford University</span></span>
</figcaption>
</figure>
<p>The entirety of John Gower’s 14th-century poem, <a href="http://d.lib.rochester.edu/teams/publication/peck-confessio-amantis-volume-1"><em>Confessio Amantis</em></a> (The Lover’s Confession), is framed around a melancholic lover who complains to Venus and Cupid that he is sick with love to the point that he desires death, and requires a medicine (which he has yet to find) to be cured.</p>
<p>The lover in <em>Confessio Amantis</em> does, finally, receive a cure from Venus. Seeing his dire condition, she produces a cold “oignement” and anoints his “wounded herte”, his temples, and his kidneys. Through this medicinal treatment, the “fyri peine” (fiery pain) of his love is dampened, and he is cured.</p>
<p>The medicalisation of love has perpetuated, as the sciences of neurobiology and evolutionary biology show today. In 1621, Robert Burton published the weighty tome <a href="https://books.google.co.uk/books?id=jyHVBjXkPowC&amp;printsec=frontcover&amp;dq=robert+burton+the+anatomy+of+melancholy&amp;hl=en&amp;sa=X&amp;ved=0ahUKEwjwg5TpqODRAhWfHsAKHZL4CtwQ6AEIIDAB#v=onepage&amp;q=robert%20burton%20the%20anatomy%20of%20melancholy&amp;f=false">The Anatomy of Melancholy</a>. And Freud developed similar ideas in the early 20th century, in the book <a href="https://books.google.co.uk/books?id=r9UnxaOj83oC&amp;printsec=frontcover&amp;dq=freud+murder+mourning&amp;hl=en&amp;sa=X&amp;ved=0ahUKEwiNjeySquDRAhVnLsAKHbZIDfAQ6AEIHDAA#v=onepage&amp;q=freud%20murder%20mourning&amp;f=false">Mourning and Melancholia</a>. The problem of the conflicted human heart clearly runs deep.</p>
<p>So if the pain of love is piercing your heart, you could always give some of these medieval cures a try.</p><img src="https://counter.theconversation.com/content/70919/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laura Kalas Williams does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Lettuce leaves and purgatives might ease your aching heart.Laura Kalas Williams, Postdoctoral Researcher in Medieval Literature and Medicine, Associate Tutor, University of ExeterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/674942016-10-28T09:57:54Z2016-10-28T09:57:54ZDropping like flies: the rise of workplace burnout and how to tackle it<figure><img src="https://images.theconversation.com/files/143338/original/image-20161026-11256-qf6m16.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">shutterstock.com</span></span></figcaption></figure><p>Burnout is on the rise. It is a growing problem for the modern workplace, having an impact on organisational costs, as well as employee health and well-being. These include possible long-term health risks and, due to its contagious nature, a toxic working environment of low morale, scapegoating, and increased office politics. </p>
<p>The annual cost of burnout to the global economy <a href="https://science.report/pub/33910920">has been estimated to be £255 billion</a>. Such costs have led to the World Health Organisation predicting a global pandemic <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393815/">within a decade</a>.</p>
<p>Organisations have focused on burnout <a href="http://www.personneltoday.com/hr/employee-health-wellbeing-programmes-time-look-beyond-cash-returns/">to protect their profits</a>, placing blame for lowered performance on individual employees, rather than making adequate adjustments <a href="http://www.convergeinternational.com.au/docs/ezine-article/rtk_stress-prevention.pdf">to safeguard against stress</a>. This emphasis on the employee has led to psychometrically profiling those that may be at risk of burnout due to their psychological make-up, rather than organisations taking responsibility and making systematic changes to reduce stress caused by <a href="http://www.theworkfoundation.com/downloadpublication/report/69_69_stress_at_work.pdf">structural level problems</a>. </p>
<p>This blame game is often unhelpful. Not just for the employees in question, but also because it risks a skills shortage in certain professions such as health and social care. Plus, it further contributes to the burnout cycle: with limited staff and resources, demands are placed on fewer employees. </p>
<h2>Causes</h2>
<p><a href="http://www.drjimmirabella.com/dissertations/dissertation-saracook.pdf">Research into burnout</a> has been linked to office politics, menial working tasks that interfere with work duties and high job demands that lead to exhaustion. Rising workloads and long hours are the main culprits; however, some employees are better able to cope or are more adaptable than others. </p>
<p>Perception of stress is also a contributing factor. If you perceive you do not have the right resources to cope with your workload, or perceive it to be more than you can cope with, you are much more likely to succumb to stress-related disorders. </p>
<p>Individual differences and personality types also play a role in the risk of burnout. Type A personalities, for example – who have a mix of behavioural traits that include hardiness, impatience, competitiveness and drive – and people who like to have large amounts of control, are also linked to higher rates of stress at work. Research shows that employees with these personalities tend to be more restless, hostile and time-conscious, which <a href="http://www.beanmanaged.com/doc/pdf/arnoldbakker/articles/articles_arnold_bakker_348.pdf">puts them at greater risk of workplace stress</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/143444/original/image-20161027-11260-1a4mxmy.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip">
<figcaption>
<span class="caption">Stressed out.</span>
<span class="attribution"><span class="source">baranq from shutterstock.com</span></span>
</figcaption>
</figure>
<p>It is important, however, not to make banal assumptions when it comes to understanding how different people experience stress. This runs the risk of organisations screening out applicants for jobs on the basis of personality or attributing blame to employees, rather than taking responsibility as an organisation to make adequate changes to safeguard their employees from stress. </p>
<p>Many global organisations have intervention plans that <a href="http://www.personneltoday.com/hr/stress-what-works-and-what-doesnt/">place the onus on the employee</a> to manage their health and well-being through training programmes such as building resilience and coping skills. But this often has the semblance of blaming employees, while abdicating responsibility and not making any real changes to policies. The reality is that organisations are stressful, often purporting an employee wellness agenda that isn’t really implemented in practice.</p>
<h2>Different dimensions</h2>
<p>There are three main dimensions of burnout according to the <a href="https://www.researchgate.net/publication/277816643_The_Maslach_Burnout_Inventory_Manual">Maslach Burnout Inventory</a>, the most commonly used burnout scale: exhaustion, cynicism and a sense of personal accomplishment, with exhaustion being the most obviously displayed. Signs of burnout can vary between employees and manifest in multiple industries, from healthcare and education settings to legal and corporate finance firms. </p>
<p>Burnout causes a range of <a href="https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024813/">psychological</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931238/">and physical problems</a> and can affect people long after they no longer face the stressful situation. These include fatigue, irritability, depression, withdrawal, mental and physical health problems, and self-medication with alcohol and drug use. Consequently, it is something that employees and organisations must manage carefully. </p>
<p>Employees come in all shapes and sizes. As a result, it is imperative that managers and organisations do not prescribe a one-size fits all model to managing employee well-being. Instead, they should work on an individual basis with each employee, finding flexible interventions and providing an adaptable and agile working environment along the way. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/143445/original/image-20161027-11236-m5qzm8.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip">
<figcaption>
<span class="caption">Employees come in different shapes and sizes.</span>
<span class="attribution"><span class="source">trexdruid from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Many workplaces are built around teamwork, collaboration and endless meetings to harness creativity. This model does not bode well, however, for people whose creative juices and energy levels are depleted through constant collaboration. In fact, many individuals, especially those that are more introverted, feel exhausted and find it difficult to get their work done in this kind of environment. </p>
<p>As such, organisations can provide a space for these personalities to work alone, where their productivity increases and creative juices can flow. Similarly, organisations can work with employees, providing agile working conditions to help create a sustainable working culture and work-life balance, thus reducing the likelihood of burnout. </p>
<p>Of course, individuals have a role to play too. It is important that people manage their own personal expectations, harnessing their skills and reflecting on their own personal values. This is particularly the case if you’re working in a role that does not readily align with your own values or predisposition. It’s important to reflect on what matters to you, as living an inauthentic life can lead to burnout when your personal values are conflicted.</p><img src="https://counter.theconversation.com/content/67494/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Tottle does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Burnout is a growing problem for the modern workplace. It has an impact on organisational costs, as well as employee health and well-being.Sarah Tottle, Business psychologist, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/573102016-04-06T12:23:56Z2016-04-06T12:23:56ZThe philosophical role of illness – and how it can teach us to live reflectively<figure><img src="https://images.theconversation.com/files/117661/original/image-20160406-29010-15ihumq.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">Illness makes us think</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-367762532/stock-photo-dementia-brain-loss-memory-problem-and-aging-due-to-cognitive-disease-and-alzheimer-s-illness-as-a.html?src=bsgQx1qI7f_zX7x5tHU5DA-1-18">Shutterstock</a></span></figcaption></figure><p>Serious illness is a great calamity. It is unwelcome, violent, frightening and painful. If it is life threatening, it requires the ill person and their loved ones to confront death. Illness causes pain, anxiety, incapacitation; it limits what the ill person can do. It can cut a life short, stop plans in their tracks, and detach people from life, suspending the previous flow of everyday activity. In short, illness is almost always unwelcome but must be endured, as it is also unavoidable. We “each owe nature a death”, as <a href="http://www.bbc.co.uk/history/historic_figures/freud_sigmund.shtml">Freud</a> put it.</p>
<p>But illness also has revelatory power. It pushes the ill person to the limit and reveals a great deal about us, how we live, and the values and assumptions that underpin our lives. Illness can also provide both philosophical motivation and instruction, by pointing to our habits and assumptions and putting them into question. So we should consider illness as a legitimate and useful philosophical tool.</p>
<p>What kind of a philosophical tool is illness? First, illness uncovers aspects of embodied experience with tremendous force. It shows us the frailty and failure of the flesh, revealing dimensions of human existence that are both tacit and surprising. Illness is therefore an opportunity for us to reflect on the nature of such bodily existence, its limits, and how it conditions our lives.</p>
<p>Second, illness is (at present) an integral part of biological life and so must be taken into account when considering human life, values, meaning and social arrangements. We are all destined to die, <a href="http://www.who.int/mediacentre/factsheets/fs310/en/index2.html">and most of us will fall ill</a> (or are ill) in the process. This is a significant fact about human life that both structures and delimits it.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/117659/original/image-20160406-28945-tt7hqn.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=237&amp;fit=clip">
<figcaption>
<span class="caption">Sigmund Freud ‘owed nature a death’.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File%3ASigmund_Freud_LIFE.jpg">Max Halberstadt</a></span>
</figcaption>
</figure>
<p>Third, illness has what <a href="https://www.routledge.com/products/9781844657537">I call a ‘distancing effect’</a>. It withdraws us from previous habits, routines and practices, which become impossible in illness, and forces us to reflect on those habits and practices. Illness can destroy the expectations we have about our life, such as assumptions about how long we might live and how independent we should be, and in this way reveals the values we take for granted, many of which are only articulated explicitly when one falls ill.</p>
<h2>Reflective living</h2>
<p>In short, illness leads us to question how we live, why we live as we do, and how we might continue to do some things within the constraints of illness. Illness is a challenge, a demand, that requires a reflective response. Illness radically changes our relationship to our body, environment, and social world. </p>
<p>It changes our attitude towards time and the future. It often forces us to consider what is important and what is trivial. It can furnish us with new clarity and focus, and it can lead us to appreciate things we were previously too busy to notice. As such, illness can awaken reflection in the ill person simply by forcing change on that person. This reflection is, simply put, <a href="http://www.open.ac.uk/Arts/philosophy/whatis.shtml">philosophising</a>.</p>
<p>So, for me, <a href="http://onlinelibrary.wiley.com/doi/10.1111/meta.12065/abstract">illness is a unique form of philosophising</a>. We normally think of philosophising as a chosen activity, not something that can be forced on someone. But in the case of illness, the ill person is thrust into great uncertainty, anguish, incapacity, and anxiety and these may lead that person to ask philosophical questions about justice, luck and misfortune, autonomy and dependence, and about the meaning of their life.</p>
<p>Illness is a <em>violent invitation</em> to philosophise. It arrives, unwelcome, wreaking havoc on a previously ordered life, and throws into the air many of our assumptions and ideas about what our life could and should be like. As such, it may be an effective philosophical tool that can yield important insights. Illness can call for more radical and personal methods of doing philosophy. It can affect the philosophical concerns of the ill person. It triggers reflection on finitude, disability, suffering and injustice. It can also change the urgency and salience of particular philosophical topics.</p>
<p>Of course, illness won’t do this in every case. If the illness is too painful or debilitating, there is no room for reflection. If the sorrow and trauma are too great, there can be no “post-traumatic growth”, as psychologist <a href="http://www.stern.nyu.edu/faculty/bio/jonathan-haidt">Jonathan Haidt</a> calls it. But in other cases, illness can be a transformative experience, as philosopher <a href="http://lapaul.org/">L.A. Paul</a> defines it. It can alter what we know and what we value in ways that are deeply life changing.</p><img src="https://counter.theconversation.com/content/57310/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Havi Carel receives funding from the Wellcome Trust (Senior Investigator Award 103340). </span></em></p>Illness can have a major impact on our view of the world. Sometimes, it can be enlightening.Havi Carel, Professor of Philosophy, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/554052016-03-09T08:12:55Z2016-03-09T08:12:55ZWhere people live influences whether they stop working before pension age<figure><img src="https://images.theconversation.com/files/113567/original/image-20160302-25891-qk9ea.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Goodluz/www.shutterstock.com</span></span></figcaption></figure><p>The longer life expectancy of people in industrialised countries means governments are raising the ages at which citizens can <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/263942/35062_Autumn_Statement_2013.pdf">apply for state pensions</a>. </p>
<p>In the UK, <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/221222/ihr13.pdf">state pension age</a> for both men and women is set to rise to 66 by October 2020, and 68 by 2046. Now the government has <a href="http://www.theguardian.com/money/2016/mar/01/state-pension-age-could-rise-faster-than-expected-say-experts">launched a review</a> to look at whether it should rise even higher in the future.</p>
<p>Currently, over half of the population <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/319948/fuller-working-lives-background-evidence.pdf">stops working before</a> they reach state pension age. Yet, those people who stop work before the retirement age don’t do so <a href="http://www.tandfonline.com/doi/abs/10.1080/00343400600757635?journalCode=cres20">at the same rate</a> across the country. The percentage of the British working age population claiming the Employment and Support allowance (formerly called incapacity benefit) tends to be <a href="http://www.parliament.uk/briefing-papers/sn01420.pdf">highest in the north and lowest in the south and east of England</a>.</p>
<p>As governments plan for the future, and try to develop interventions to stop older people leaving their jobs before the retirement age, they need to know what factors are really causing these inequalities in what is called “worker retention”. </p>
<p>Previous studies in the <a href="http://www.tandfonline.com/doi/abs/10.1080/00343400600757635">USA, UK,</a> <a href="http://sjp.sagepub.com/content/41/2/158?ijkey=4dc68a9dffcb3707224377ffcde6ca0074922f7d&amp;keytype2=tf_ipsecsha">Norway</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/21183470?access_num=21183470&amp;link_type=MED&amp;dopt=Abstract">Iceland</a> have shown that in areas where there are more unemployed people, there also tend to be more people who receive disability pensions, suggesting that the two are linked. </p>
<p>But <a href="http://eurpub.oxfordjournals.org/content/early/2016/02/27/eurpub.ckw005">our new research</a> has shown over the course of the last recession, this was not the case. People who left the workforce between 2001 and 2011 either did so because of their health, or because of the job market in the area where they lived – the two were not linked. </p>
<h2>What happens in a decade</h2>
<p>Colleagues from the <a href="http://www.ucl.ac.uk/renewl">Research on Extended Working Lives (RenEWL) consortium</a> and <a href="https://iris.ucl.ac.uk/iris/browse/profile?upi=EMURR58">I</a> set out to address this issue using data from the <a href="http://celsius.lshtm.ac.uk/what.html">Office for National Statistics Longitudinal Study</a> – a 1% representative sample of all people who answered the census in England and Wales.</p>
<p>We only included people in the study who were in work and aged 40-69 years at the 2001 census. We then assessed whether their work status had changed at the next census, in 2011. If the participants were not in work, they could identify themselves as being long-term sick or disabled, retired, a student, looking after their home or family, or “other”.</p>
<p>We <a href="http://eurpub.oxfordjournals.org/content/early/2016/02/27/eurpub.ckw005">found that older workers</a> living in areas with higher unemployment in 2001 were less likely to be in work ten years later than people who lived in areas with lower unemployment. This was true both if the person had given the reason for being out of work in 2011 as sickness or disability, or if they had simply retired. </p>
<p>Overall, many more people in our study left the work force due to retirement rather than sickness or disability reasons (29% versus 3%). As the graph below shows, older people living in areas of high unemployment were around 1.7 times more likely to be out of work due to a long-term sickness or disability in 2011, and 1.2 times more likely to be retired, than those living in areas of low unemployment. But this did not necessarily mean that they left the workforce because of their disability. </p>
<p><figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/113137/original/image-20160228-26716-8u1th0.JPG?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip">
<figcaption>
<span class="caption">Odds ratio of reporting being sick/disabled and retired in 2011, vs. in work, by local authority area unemployment conditions and individual.
health status in 2001.</span>
</figcaption>
</figure></p>
<h2>For health reasons</h2>
<p>We also looked at whether people with poor health, who are more likely to exit the work force over the decade, also tend to live in areas of high unemployment. Our study suggests not. We found that how healthy a person was could not explain why people in some areas left work earlier than those in other areas. Nor could this be explained by their gender, age, employment status (full-time or part-time), social class, ethnic group or whether they owned their own home.</p>
<p>In fact, among those respondents that identified as sick or disabled in 2011, those who rated their own health better were more likely to be out of work because of unemployment in their area. As the graph below shows, for people who had good and fairly good health, living in an area with higher unemployment meant that they were more likely to be out of work a decade later (the triangles move up). For people in poor health, they are out of work no matter where they live.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/113139/original/image-20160228-26719-1ls5en9.JPG?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip">
<figcaption>
<span class="caption">Odds ratios of reporting being sick/disabled in 2011, vs. in work, stratified by local authority area unemployment conditions and individual health status in 2001.</span>
</figcaption>
</figure>
<p>This is not to say that health was not a driver for people stopping work. Health was very strongly related to work force exit for all inactive groups, and people in poor health in 2011 were almost six times more likely not to be in work ten years later. But the overall picture seen in our study is that where people live and their health are not linked – they are independent predictors of whether older people stay in work.</p>
<p>Our study does not yet clarify exactly what is driving people in areas with higher unemployment to leave the work force. But in the current economic climate of austerity, these findings hold an important message: that policies and programmes designed to retain people in the workforce in the middle of their lives may be most effective if targeted to those areas of the country that already have higher unemployment.</p><img src="https://counter.theconversation.com/content/55405/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This work is jointly funded by the Economic and Social Research Council and Medical Research Council under the Lifelong Health and Wellbeing Cross-Council Programme initiative.</span></em></p>Health and local employment prospects both play a part in whether older workers stop working.Emily Murray, Senior Research Associate, Department of Epidemiology & Public Health, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/533842016-02-07T19:06:05Z2016-02-07T19:06:05ZChildren as young as four can learn how to avoid getting ill, if they understand why<figure><img src="https://images.theconversation.com/files/109636/original/image-20160129-27351-1jc2p1p.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">Asking your child to wash their hands before they eat isn’t useful unless they know why it’s important.
</span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Learning about illness is unlike learning about other things: it requires children to reason about objects like “germs” that they can’t see or touch.</p>
<p>Although children have some difficulty of grasping the concept of illness and how illness is transmitted, children begin to learn about it in the preschool years. </p>
<p>At first, they acquire very basic knowledge about illness transmission, and can provide accurate explanations for how someone might have gotten sick. </p>
<p>For example, when <a href="http://www.sciencedirect.com/science/article/pii/S0010028508000467">researchers</a> asked a group of preschool-aged children how another child might have become sick after a sequence of events, even three year olds were able to list accurate explanations for contracting the illness, spontaneously citing germs or contact with a bodily fluid. </p>
<p>But preschoolers’ knowledge isn’t quite complete and they still make mistakes. </p>
<p>For example, the same three year olds had trouble making predictions about who would get sick a day later based on whether they engaged in a risk behavior like eating a contaminated food. </p>
<p>Other studies have shown that five year olds have trouble differentiating between various illnesses, and think that non-contagious illnesses like <a href="jbd.sagepub.com/content/32/5/443.short">cancer</a> and mental illnesses like <a href="http://onlinelibrary.wiley.com/doi/10.1348/026151009X461366/pdf">depression</a> are as contagious as the common cold. </p>
<p>It isn’t until a few years later that children acquire a more sophisticated understanding of illness transmission and can make predictions about how engaging in risky behaviours might make someone sick, and differentiate between illnesses that are contagious and illnesses that are not.</p>
<h2>How children behave when faced with contamination</h2>
<p>Children’s behavior seems to lag a bit behind their verbal understanding of illness transmission, and preschoolers are generally happy to engage with objects — even foods — that have been contaminated. </p>
<p>In one <a href="http://psycnet.apa.org/journals/dev/21/6/1075/">study</a>, researchers presented three- to 12-year-old children with a glass of apple juice and systematically put various objects into the juice. They later asked the children if they wanted to take a drink. It wasn’t until age six that most children rejected the juice when a dead grasshopper was visibly floating inside, and even then, some of the older children still drank it. </p>
<p><a href="http://www.sciencedirect.com/science/article/pii/S0195666314007831">Similarly</a>, another study showed that after watching a video of two actors eating applesauce out of two bowls, two- and four-year-old children ate applesauce from both, including one that had been sneezed in by one of the actors. </p>
<p>It was not until ages five to eight that children ate more applesauce from the clean bowl than from the contaminated bowl; and even then, most of them still ate some of applesauce from the bowl that was sneezed in. </p>
<h2>Teaching children to stay healthy</h2>
<p>Most preschool-aged children don’t necessarily understand illness transmission and how to actively take steps to avoid getting sick until middle childhood–not until children are older than six or seven.</p>
<p>However, my own research suggests that we can teach kids as young as four some healthy habits if we give them the right kind of information. </p>
<p>We <a href="http://www.sciencedirect.com/science/article/pii/S0022096515002593">found</a> that four- to seven-year-old children who knew that touching a sick person might make them sick later avoided touching the toys of an experimenter who they thought might have a cold. </p>
<p>Even the youngest children who happened to know that interacting with a sick person could make them sick avoided contact with a potentially sick experimenter. The implication here is that even children as young as four and five are capable of learning how illnesses spread; most of them just haven’t yet. </p>
<h2>Tips for parents</h2>
<p>Children do not <a href="http://www.sciencedirect.com/science/article/pii/S0010028508000224">learn much</a> if you just teach them a list of dos and don’ts, like “wash your hands before you eat,” or “don’t go outside without a hat”. </p>
<p>The key is to explain why something like washing your hands might be useful. In other words, you can tell a child to wash their hands before they eat, but it might not be effective in promoting healthy behaviour unless you tell them that exactly what they are washing off and how it could make them sick. </p>
<p>In the end, talking to children specifically about germs and how germs spread might be the most effective strategy in promoting healthy behaviours, even in preschoolers.</p><img src="https://counter.theconversation.com/content/53384/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vanessa LoBue does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Children don’t learn much about how illnesses spread if they are just taught a list of dos and don’ts. They need to know why an action is useful.Vanessa LoBue, Assistant Professor of Psychology, Rutgers University Newark Licensed as Creative Commons – attribution, no derivatives.